| NPI | 1861620007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MA 261931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD447302) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194411) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-07-07 |